Sleep is a very important function for living things, and the human species makes up a third of these living creatures. A sleep disorder is when a person suffers from poor or inadequate sleep. Sleep disorders can include irregular movements while a person is sleeping, too much-perceived sleep quantity or the lack of adequate sleep. Sleep disorders are a common occurrence and they can bring about serious effects on the health as well as the quality of life of a person. However, most of these sleep disorders can be easily controlled using appropriate interventions. In spite of that, there are still some sleep disorders that are more difficult to treat and manage. Comment by Sue Okun: APA format: indent the first line of every paragraph Comment by Sue Okun: This would be a good place to 1) identify what are those more difficult sleep orders to treat and 2) what is the specific research question that you are going to review in this document. That would really help you focus the development of future sections of the Lit Review. Your title suggests your research problem (“Use of Sleep Studies in Sleep Apnea,” so this would be where you would explain that question in depth. What about sleep studies will you be looking at? Effectiveness in diagnosis of sleep apnea? Effectiveness in the treatment of sleep apnea? Both?
Background
Pavlova and Latreille (2019) suggest that there are various types of sleeping disorders. The main sleep disorders include Insomnia; Circadian Rhythm Sleep Disorders; Sleep Disordered Breathing: Obstructive Sleep Apnea and Central Sleep Apnea; Hypersomnia: Narcolepsy and Idiopathic Hypersomnia; Parasomnias: Non-Rapid Eye Movement Parasomnias and Rapid Eye Movement Behavior Disorder; Restless Legs Syndrome and Periodic Limb Movements of Sleep.
This paper mainly focuses on sleep apnea. Termed as obstructive sleep apnea, this type of sleep disorder is distinguished by pauses of breathing while an individual is sleeping. This disorder exists in three different forms, namely: central sleep apnea, obstructive apnea, and the complex sleep apnea. The obstructive apnea is described as an airflow pause that happens for almost ten seconds and it is caused by the caving in of the upper way when one is sleeping. On the contrary, central apnea happens when there is an insufficient effort to breathe, which typically takes place from the brain respiratory centers up to the muscles that control the breathing pattern in individuals. This results into the disruption of airflow. A number of people have a mixture of the obstructive apnea and the central apnea and this is now known as the complex sleep apnea (Pavlova and Latreille, 2019). Comment by Sue Okun: Explain why you have chosen to focus on sleep apnea (you do a convincing job of that in the next section, where you talk about how common sleep apnea is and how it is related to so many other health conditions. I would have put all of that information in one “background” section, and shortened it.)
Evaluation of Sleep Apnea Comment by Sue Okun: This heading throws me off a little—is this section really about “Evaluation” of sleep apnea? I’m not sure what you mean by “evaluation” here. Do you mean “prevalence” of sleep apnea?
According to Javaheri et al. (2017), sleep apnea is usually extremely prevalent in people who suffer from heart/ cardiovascular disease. Cardiovascular disease (CVD) resulted in 31% of the total deaths in the United States of America in the year 2013. This is almost 800, 000 people. In Americans of 65 years of age, the number was 155, 000 deaths. It is estimated that by the year 2030, 920 billion dollars will be used to cover the CVD medical costs. Obstructive sleep apnea (OSA) has a high prevalence, which totals 34% of males and 17% of females. It is largely undiagnosed, and this sleep disorder is a variable risk factor of CVD.
Systematic hypertension (HTN) occurs as a result of OSA and it is linked with a higher number of stroke incidences, heart failure (HF), coronary heart disease (CHD) and atrial fibrillation (AF). When OSA is specifically severe, it is linked with augmented all-cause plus cardiovascular (CV) mortality. Central sleep apnea (CSA) is very common in people with atrial fibrillation, heart failure, and stroke, but quite uncommon in the general populace. On the other hand, recent studies have shown that CSA is additionally a risk aspect for HF and incident AF. OSA is strongly linked with the other CVDs comprising of pulmonary hypertension (PHTN), transient ischemic attack (TIA), resistant HTN, myocardial infarction (MI), myocardial ischemia and also sudden death (Javaheri et al., 2017).
Sleep Apnea Diagnosis and Treatment
This disorder is usually diagnosed during what is known as polysomnography. Pavlova and Latreille (2019), state that this is “where the severity of sleep apnea is quantified by the number of respiratory events per hour of sleep” (p. 4). At least 5 events occurring per hour are needed in order to diagnose sleep apnea, alongside clinical symptoms. Mild sleep apnea is considered when a person has between 5 and 14 events every hour, while between 15 and 29 events every hour is thought out to be moderate sleep apnea and, a number higher than 30 events every hour is what is considered as severe sleep apnea.
There are several treatment options that are available for the treatment of sleep apnea. These treatment options usually depend on the severity of the disorder. There are conservative therapies which take in such things as weight loss for the treatment of mild to obstructive sleep apnea. For positional sleep apnea, steering clear of supine position is very helpful. The commonly used and acknowledged sleep apnea treatment is positive airway pressure therapy (Javaheri et al., 2017). This type of therapy involves a nonstop flow of air that is directed to the nose. There is also bilevel positive airway pressure (BPAP) therapy which offers a sleep apnea patient with elevated pressure on inspiration and a lesser pressure level on expiration.
Shangold (2019) depicts explains? that the diagnosis and treatment of OSA is conducted by otolaryngologists and they use some tools in order to do this and find out the treatment option that is best for their patients. The most common tool that is used is the sleep study. This kind of test measures precise parameters in order to determine the OSA degree in a person, along with other things. It can be utilized diagnostically or to measure a patient’s response to treatment, for instance, oral appliance or surgery (Gelir et al, 2014). This sleep study can be conducted in two places, either the home of the patient or in a laboratory. Normally, it is carried out at night. The sleep test can however at times be carried out during the day for patients such as those who work night shifts and sleep during the daytime. The sleep study can also be used as a therapeutic method in trying to treat OSA patients. It can be used as CPAP, BPAP, or ASV (adaptive servoventilation) titration. CPAP and BPAP therapies are commonly used on patients with OSA, while ASV is a treatment method for patients with either central or complex sleep apnea (Shangold, 2019). Comment by Sue Okun: Your discussion gets a little muddled here where you start talking about both diagnosis (with discussion of sleep studies) and treatment. Tons of good information here—organizationally it might be effective to clearly separate your discussion of diagnosis and treatment. Comment by Sue Okun: So, this is the first time since the title that you are discussing the idea of the sleep study (other than saying the disorder is usually diagnosed during polysomnography (above). Since it’s the focus of your research problem, I would discuss it earlier. Comment by Sue Okun: What does the research say about these treatments? Are they effective? Equally effective?
Aurora et al. (2016), suggests that OSA can be treated even without the use of the specialists – otolaryngologists. They conducted a study that showed there were similar results of the home sleep study therapy for OSA with and without the presence of the sleep specialist. 191 subjects were used, with 56.5% of them having OSA. Only 5.8% of this number was not recognized without using a sleep specialist. There were 16.8% misclassifications when comparing the assessment of the disease acuteness with both the presence and absence of a sleep specialist. OSA can be consistently recognized using a non-referred model, irrespective of the pretest possibility of daytime sleep predisposition or pretest possibility (Aurora et al., 2016). Comment by Sue Okun: This is an interesting sub-question about sleep studies—can they be done effectively without a specialist?
This is controversial as Pack (2015) states that polysomnography (PSG) does give way to better results than home sleeping. There is little uncertainty that home sleep studies can be utilized for OSA diagnosis. This is sustained confirmed? in the randomized trials that contrasted the results of PSG in the laboratories or at home sleep studies in patients with OSA. They utilized an interesting model to assess whether in a person the therapeutic choice was made with information from the lab PSGs as well as from the home studies. PSG has been for a long time thought of as the “golden standard” for OSA diagnosis (Pack, 2015, p. 3). Comment by Sue Okun: Nice. I like how your discussion of sleep studies/polysomnography is developing in this part of the Lit Review.
There are a number of studies that have been carried out in order to assess the effectiveness of the therapies in the diagnosis of sleep apnea. The continuous positive airway pressure (CPAP) therapy, when used on patients with obstructive sleep apnea, has shown improvements in lessening subjective daytime sleepiness enhance cognitively, enhance their cognitive functioning plus the quality of life, glucose control and blood pressure (BP). Obesity has been linked to hypertension which also causes OSA. Chirinos et al., (2014) carried out a study to determine whether CPAP or weight loss or both of these therapies were beneficial for OSA patients suffering from obesity. From the study, it was determined that CRP levels were not reduced using both CPAP and weight loss methods for adults suffering from obesity and OSA. When weight loss was used together with CPAP, there was a reduction in the insulin resistance levels as well as reduced BP when compared with each of the interventions used alone (Chirinos et al., 2014). Comment by Sue Okun: Citation? Comment by Sue Okun: Citation?
Another study was conducted to compare CPAP vs. oxygen in the treatment of OSA. Gottlieb et al. (2014) carried out a randomized controlled trial where CVD patients with OSA to establish which therapy between CPAP and nocturnal supplemental oxygen were more effective. The patients with CVD or numerous cardiovascular risk aspects that used CPAP therapy for their OSA showed results of low blood pressure, just as the abovementioned study. The nocturnal supplemental oxygen therapy used on the OSA and CVD patients only showed a very low level (Gottlieb et al., 2014). Senaratna et al., (2018), also carried out a study that compared apnoea-hypopnea index and the oxygen desaturation index when recognizing obstructive sleep apnea using type-4 sleep studies. Both these studies showed that the sleep studies were indeed beneficial in the diagnosis and treatment of obstructive sleep apnea. Due to the increasing number of people suffering from OSA, more focus has been emphasized on the diagnostic methods. There is type- 2, type-3 and, type- 4 sleep studies and they are very critical in the diagnosis and treatment of OSA (Senaratna et al., 2018).
Summary
These studies have their own strengths and limitations. Despite that, they have shown that sleep studies have been effective in the diagnosis of sleep disorders. They have also been very helpful in the treatment of patients with OSA and CVD. However, even though home sleep testing provides comfort and reliability for the OSA and CVD patients, PSG is still the best as there are not many other options. However, critics dispute that the sensitivity, as well as specificity of the home sleep testing for evaluating OSA, are substandard to PSG. Can researchers come up with a better and effective sleep study for diagnosing sleep disorders? Can they also come up with sleep tests that do not require repeat testing like the home sleep tests? Can they also come up with a range of sleep studies that have lower failure rates than the existing ones?
Content: You have provided a well-written literature review where you have critically synthesized at least ten reputable sources, identified at least one current controversy in the literature, and suggested questions for future research. Your writing is clear and shows thought and care. The one weak spot was the absence of clearly stated research problem at the outset. This would have allowed you to guide the reader through your research and analysis.
Grammar/Punctuation/Mechanics: Overall, your Lit Review was well-organized and you demonstrated strong mechanics. I made a few suggestions on the structure of the analysis and Background/Introduction sections, but overall it was well done. Good use of APA formatting.
Peer Review: you did a good job providing comments to your peer who submitted his draft on time. Thank you.
References
Aurora N.A., Putcha N., Swartz. R. and Punjabi N.R. (2016). Agreement Between Results of Home Sleep Testing for Obstructive Sleep Apnea with and Without a Sleep Specialist. The American Journal of Medicine 129, 725-730
Chirinos J.A., Gurubhagavatula I. and Teff K. et al. (2014). CPAP, Weight Loss, or Both for Obstructive Sleep Apnea. The New England Journal of Medicine. Vol. 370 no. 24 p. 2265- 2275 DOI: 10.1056/NEJMoa1306187
Gelir E., Budak M.T. and Ardic S. (2014) The Relationship between CPAP Usage and Corneal Thickness. PLoS ONE 9(1) Retrieved from: e87274. doi:10.1371/journal.pone.0087274
Gottlieb D.J., Punjabi M.N. and Mehra R. et al., (2014) CPAP versus Oxygen in Obstructive Sleep Apnea. The New England Journal of Medicine 370: 2276-85. DOI: 10.1056/NEJMoa1306766
Javaheri S., Barbe F., Campos-Rodriguez et al. (2017). Sleep Apnea. Journal of the American College of Cardiology Vol 69, No. 7, p. 841-859 Retrieved from; h t t p : / / d x . d o i. o r g / 1 0. 1 0 1 6 / j. j a c c. 20 1 6. 1 1. 0 6 9
Kingshott R.N., Gahleitner F, Elphick HE, et al (2018). Cardiorespiratory sleep studies at home: experience in research and clinical cohorts. BMJ Retrieved from: doi: 10.1136/archdischild-2018-315676
Pack A.I. (2015). Does Laboratory Polysomnography Yield Better Outcomes Than Home Sleep Testing? Yes. Chest 148 (2) p. 306-308D OI: 10.1378/chest.15-0477
Pavlova M.K. and Latreille V. (2018). Sleep Disorders. The American Journal of Medicine Vol 132, No. 3 p. 292- 299 Retrieved from: https://doi.org/10.1016/j.amjmed.2018.09.021
Senaratna C.V., Lowe A. and Perret L. J. et al. (2018) Comparison of apnoea–hypopnoea index and oxygen desaturation index when identifying obstructive sleep apnoea using type‐4 sleep studies. Journal of Sleep Research p. 1-20. Retrieved from: https://doi-org.proxygw.wrlc.org/10.1111/jsr.12804
Shangold L. (2016) How to Evaluate a Diagnostic Sleep Study Report Otolaryngology Clin N Am Vol 49 p. 1307–1329 Retrieved from: http://dx.doi.org/10.1016/j.otc.2016.07.003
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